Provider Demographics
NPI:1992791354
Name:IVKOV, BORIS BERNARD (MD)
Entity type:Individual
Prefix:DR
First Name:BORIS
Middle Name:BERNARD
Last Name:IVKOV
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Gender:M
Credentials:MD
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Mailing Address - Street 1:184 EAST 70 STREET SUITE B-1
Mailing Address - Street 2:EAST SIDE MEDICAL AND CARDIOVASCULAR ASS, PC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-249-1760
Mailing Address - Fax:212-249-2054
Practice Address - Street 1:184 EAST 70 ST SUITE B1
Practice Address - Street 2:EAST SIDE MEDICAL AND CARDIOVASCULAR ASS, PC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-249-1760
Practice Address - Fax:212-249-2054
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2021-02-23
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Provider Licenses
StateLicense IDTaxonomies
NY210772207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G79455Medicare UPIN